Arizona urgent-care operator to pay $12.5 million for overbilling

An Arizona urgent care provider was ordered to pay $12.5 million for overbilling, the Justice Department announced Thursday.

Phoenix-based Urgent Care Extra created patient care practices and billing procedures to overstate the medical complexity of its services, drawing millions in inflated payments from hundreds of insurers from 2012 to 2016. Urgent Care Extra also admitted to encouraging staff to order unnecessary tests and procedures to justify higher billing codes.

“Greed-driven schemes like this one drive up healthcare costs and hurt all Americans,” U.S. Attorney Michael Bailey said in prepared remarks. “This excellent investigation by the FBI and IRS will send a clear message to healthcare providers that fraudulent billing will be held to account.”

One insurer, who lost $2 million in the fraud, said that upcoding causes billions of dollars in losses across the industry every year, which often results in higher premiums for patients, court documents show.

Banner Health purchased Urgent Care Extra’s 32 locations for a “reduced price” in 2016 and rebranded them as Banner Urgent Care. Urgent Care Extra operators were debarred as medical providers in 2017.

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